BIOL122-Human Biological Science 2
Case Study 1, part 1- Neurological disorders
Mary-Lou is a 75-year-old widow, who lost her husband to cancer over a year ago. Her family and friends have noticed that she has been very teary, has low self-esteem, and has lost interest in the things she used to love such as going to bingo with her friends and gardening. Her family initially put this down to the loss of her husband and thought it would pass with time. However, they are now getting really concerned as they have noticed that her mood is not improving still. When asked by her daughter if she is sleeping well, she says she has been drinking wine every night to help her go to sleep. It also makes her feel happy and relaxed. However, what started as one glass a night has now increased to two or three glasses a night, and she has also started drinking during the day. Her daughter has noticed that her mum’s face always appears flushed and that she has had quite a few colds lately. Mary-Lou is also losing her balance and experiencing mood swings. Her daughter is worried that she is relying too heavily on alcohol and fears that she is starting to get short-term memory loss from the alcohol consumption. She has been forgetting things such as where she put her keys, whether she turned on the washing machine, or why she opened the fridge. She also tends to forget the topic of conversation when talking with her daughter on the phone. Mary-Lou has also been getting disorientated and getting lost when she goes out on her daily walks. A neighbor rang her daughter one day to tell her that she found Mary-Lou wandering around aimlessly, and when questioned what she was doing, Mary-Lou snapped and said she was trying to get home. Her daughter decided it was time to take Mary-Lou to the local GP to work out what was going on with her.
After listening to the signs and symptoms Mary-Lou was experiencing, the GP diagnosed her with several conditions and prescribed 50 mg of Fluoxetine/Prozac daily, a cholinesterase inhibitor, and 10 mg of Valium/diazepam daily. She was also given information on support groups and tips on what to do given her conditions.
Based on the clinical picture presented above, you should have identified several diseases/conditions we have covered in BIOL122.
• Name two of the diseases/conditions you identified, and
• List two characteristic signs or symptoms (per disease) that you noted in Mary-Lou’s history and clinical picture.
• Finally, explain the pathophysiology of both diseases/conditions you named (i.e., explain the changes that cause the disease and relate the typical signs and symptoms of the disease to the clinical picture).
Explain the mechanism of action of two drug types Mary-Lou is prescribed with and describe how these drug actions help mitigate some of her symptoms. In you answer, make references to the pathophysiology of the relevant diseases
Based on her clinical picture and history, explain if Mary-Lou suffers from alcohol addiction. Support your answer with relevant evidence from the case study. In your answer you should define physical and psychological dependence and explain if signs and symptoms of either can be observed in MaryLou’s case
As part of her therapy, Mary-Lou takes a new hypothetical medication (called MedX), which has narrow therapeutic index, therefore you (as a health care professional) need to exercise special care when it comes to the determination of her required dosage.
MedX is taken orally and has the following features:
• In healthy adults, the absorbed MedX is subject to first pass liver metabolism, which decreases its bioavailability to 10%.
• The active ingredient that enters the systemic circulation is water-soluble and shows very high protein binding: 98% of the drug molecules present in the plasma are bound to albumin and, to a smaller extent, α1 globulin
. • Most of the drug is excreted by the kidneys, where it is both freely filtered and actively secreted in the proximal tubule.
Based on the above properties of the drug, explain why you would recommend dose reduction in Mary-Lou’s case. In your answer, explain four (4) age-related changes in the pharmacokinetics of MedX to justify why dose reduction is necessary in the present scenario. For each of those agerelated changes described you will need to consider how the free plasma concentration of the drug is expected to change in Mary-Lou’s case compared to that of a young or middle-aged individual.
Case study 1, part 2- Musculoskeletal disorders
Mary-Lou’s family was happy with the management plan established by the doctor as Mary-Lou was progressing quite well. She was using notepads to jot down reminders, a pillbox to keep her medication organized, and a calendar to record appointments. Her family members were helping her with routine tasks such as cooking and paying bills. She was feeling much happier and did not have to rely on alcohol to go to sleep. On one particular day she was feeling so good she decided to walk to her GP appointment alone. On her way there she stumbled over a branch and fell. She felt excruciating pain in her hip. A passer-by called an ambulance and she was taken to the emergency department at the Royal Melbourne hospital. An X-ray revealed that she had broken the neck of her femur and had to have surgery to repair it.
Mary-Lou wondered whether this was linked to the crepitus she had been experiencing in her joints. Her joints did feel quite stiff and painful lately. The specialist explained to Mary-Lou that the crepitus was likely due to degeneration of her joint cartilage and said that the fracture might have been due to weakened bones. He told her he would like her to have a bone mineral density test to measure her bone density. The DEXA scan gave a T-score of -3.0. Mary-Lou is now given bisphosphonates and told to increase her daily intake of calcium.
Discuss the pathophysiology of the condition causing the crepitus Mary-Lou is experiencing in her joints. In your answer, list at least two more signs and symptoms associated with the disease.
Discuss how the aetiology of Mary Lou’s joint disease differs from the other joint disease we covered in BIOL122.
Discuss why Mary-Lou’s fracture may take longer to heal than it would for someone who was half her age. In your answer, you are expected to name and discuss three physiological factors that are needed for healing to take place and explain how each of the factors you identified is affected by ageing. Finally, name two complications of hip fracture that are prevalent in the elderly
Considering Mary-Lou’s T-score, identify the disease she suffers from, briefly describe the pathogenesis of this disease, and explain why bisphosphonate administration is helpful in this condition.
Case study 2 - Neoplasm and microbiology case study
Bruce is a 47-year-old man, who decides he needs to visit his doctor due to some gastrointestinal symptoms. At first it just started out as a bit of abdominal pain and cramping, followed by diarrhea so at first Bruce just thought he had a stomach bug. But weeks went by and the diarrhea just increased in frequency, and instead of feeling better, he started to feel really fatigued. This has been going on for 8 months before his wife finally convinced him to make an appointment with a doctor, who then referred him to a gastroenterologist. A couple of months later when he finally goes to his specialist appointment, Bruce admits after questioning that he has had bleeding with his stool but he didn’t want to tell the doctor as he was embarrassed and didn’t want to get checked for hemorrhoids. The gastroenterologist also asks many questions about Bruce’s diet and his weight and discovers that Bruce has lost 15 kg in the past year despite eating a lot of hot chips and mashed potatoes – the only thing Bruce feels doesn’t make his diarrhea worse. The gastroenterologist then tells Bruce he would like to perform a colonoscopy to investigate further.
After the colonoscopy, the surgeon tells Bruce that they found a number of polyps in his bowel which is not necessarily a cause for concern as many polyps are benign, but they will have to wait on the results of the biopsies to make sure none of them were malignant. A week later the surgeon calls Bruce, unfortunately it is bad news – the biopsy shows evidence that the growth is malignant and anaplastic and that they can’t rule out metastatic growths. Bruce is called back in for follow-up tests, and they find that there is an abnormal growth in his liver also.
Bruce is now sent to an oncologist, who recommends that he has surgery to remove any remaining polyps, a small portion of his bowel, and the abnormal growth from his liver. Based on the advice from his oncologist, Bruce also decides to undergo chemotherapy treatment. Whilst doing some routine checks after his treatment, Bruce is informed he has neutropenia.
Bruce doesn’t understand what the surgeon and oncologist are saying after the results because he doesn’t understand the terminology being used. Explain in terms a patient could understand what is meant by malignant, anaplastic and metastatic tumour, and what does this then mean for his prognosis. In order to help explain these terms, compare Bruce’s growth with a benign, differentiated and localised growth.
Describe two cancer cell characteristics or properties that allow them to become invasive and metastatic.
Explain why Bruce experiences the clinical manifestations of increased risk of infection and fatigue, both before and after treatment for his cancer.
Discuss two measures that may minimize Bruce’s chances of contracting coronavirus. In your answer, identify two different links in the chain of infection that can be broken and explain how they are broken.